BEST PRACTICE FOR INTEGRATIVE MEDICINE IN AUSTRALIAN MEDICAL PRACTICE: January 2014
Section snippets
Purpose of the guidelines
These principles aim to provide guidance for the safe and appropriate incorporation of integrative medicine (IM) into medical practice.
Definitions of Integrative Medicine
Integrative Medicine (IM) refers to the blending of conventional and evidence based natural/complementary medicines and/or therapies along with lifestyle interventions and a holistic approach – taking into account the physical, psychological, social and spiritual wellbeing of the person – with the aim of using the most appropriate, safe and evidence-based modality(ies) available.
Integrative medicine embraces and encourages a holistic approach to clinical practice incorporating patient
Standards for Integrative Medicine in Australian General Practice
The standards for integrative medicine for Australian general practice are reflected in the Integrative Medicine statement in the RACGP Curriculum for Australian General Practice2 (Appendix 1).
The Royal Australian College of General Practice (RACGP) is responsible for setting and
Rationale
The use of IM by medical practitioners, particularly general practitioners (GPs) as a part of routine clinical practice is increasing. A National Prescribing Survey (NPS) survey indicated that approximately 30% of GPs in Australia describe themselves as practising IM, by combining orthodox with CM.3
Readership
This document will be available to all medical practitioners education bodies and other specialist colleges, medical associations such as the Australian Medical Association and the Australasian Integrative Medicine Association, the Medical Board of Australia, the Professional Services Review Panel and Medicare Australia. Extensive consultation with some of these groups occurred prior to finalising the Best Practice Guidelines document.
Purpose and aim
The Best Practice for Integrative Medicine in Australian Medical Practice aims to:
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guide individual medical practitioners in the ethical and appropriate practice of IM in the context of general practice or other clinical medical settings, e.g. specialist medical practitioners,
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assist regulatory medical and professional bodies by providing suitable standards and guidelines in understanding this area of practice.
Authorship of these guidelines
The Australasian Integrative Medicine Association (AIMA) is constituted by a body of registered medical practitioners around Australia who integrate various forms of complementary medicine (CM) and holistic approaches into their medical practices.5 In recent decades there has been a steady and strong revival of interest in the general and medical communities for more holistic and natural forms of
Preamble
The Australasian Integrative Medicine Association (AIMA) recognises that medicine is not only guided by evidence and science but is also informed by tradition and experience. Current standards allow a wide degree of latitude in medical practitioners’ exercise of their professional judgement and do not preclude the use of any methods that are reasonably likely to benefit patients without undue risk. Furthermore, patients have a right to seek any kind of care for their health problems but it is
Modalities
Modalities will generally be classified under one particular domain but sometimes the modality can overlap with other domains so the following classification is open to interpretation. For example, a philosophical system like Ayurveda also include herbs, mind-body, manual and bio-energetic therapies.
The NCCAM classifies natural, complementary and alternative medicines into five categories, or domains:
Professional decision making in IM
The medical practitioner may offer the patient a conventional and/or CM treatment pursuant to a documented treatment plan tailored to the individual needs of the patient by which treatment progress or success can be evaluated with stated objectives, such as pain relief and/or improved physical and/or psychosocial function. Such a documented treatment plan shall consider pertinent medical history, previous medical records and physical examination, as well as the need for further testing,
Declaration of financial interest
Declaring to your patients your professional and financial interest in any product you might endorse or sell from your practice, and not making an unjustifiable profit from the sale or endorsement. If a practitioner has a financial or other interest in promoting a particular complementary medicine treatment, practitioner, clinic or product then this must be disclosed to patients. Failure to do this may contravene the Trade Practices Act, and be considered misleading or deceptive conduct, and
Communications and relationships
There is strong supporting research on the importance of communications and relationships between the various parties involved in the provision of healthcare for patients and their families/carers.
There are ethical and legal issues at the interface of CM and conventional medicine as addressed in a 2004 article in the Medical Journal of Australia.15
Special areas
The following areas cover patient groups where there may be issues of consent and who may be vulnerable when decisions are made about the use of complementary medicine.
Medical Indemnity Cover
It is recommended that medical practitioners contact their insurer directly to clarify any concerns about their particular area of practice. When making a clinical decision, it is important the doctor weigh the choice of treatments, assesses the scientific evidence (efficacy), any risks associated with the therapy, the clinical outcome (effectiveness) and costs associated with the treatment, and inform patients appropriately. Doctors should discuss with their current or intended indemnity
Patient autonomy, empowerment, paternalism and duty of care
These issues, probably more than any other ethical principle, underpin the rights of patients to choose the healthcare which they consider best for themselves. These factors drive much of the increasing medical and community interest in CM. Facilitated by increasingly easy access to health information and changing community attitudes, more patients are expecting their medical practitioners to be able to use or at least be able to advise about an increasingly broad range of therapies. The right
Long consultations
AIMA, together with the RACGP, supports the use of longer consultations especially in the management of chronic and complex health care problems, mental health problems, support of preventive health care and health promotion in all patients. The RACGP has provided evidence on the quality improvement outcomes arising from longer consultations in support for restructure of the current Medicare Benefit Schedule Attendance Items for General Practice. Complex care of chronic conditions often
Good Medical Practice: A Code of Conduct for Doctors in Australia
The Medical Board of Australia adopted the Code of Conduct.22
It is essential that medical practitioners be aware of the code of conduct of the Medical Board of Australia (MBA). The MBA has formally adopted the Australian Medical Council publication and has published it after making minor changes to reflect practitioners’ obligations under the Health Practitioner
Australian Medical Association
The AMA position statement23 on CM, endorsed in 2002, is provided in the appendices (see Appendix 7).
Medicare Australia
Medicare does not fund therapies that are not supported by the general body of peers. Only when treatments become accepted by the general body of peers, are MBS & PBS benefits able to be claimed. Specifically Medicare is not to be used to fund experimental or clinical trial purposes.
Doctors who practise CM have a tendency for longer consultations which places their Medicare profile outside their peers. Care of complex and chronic health conditions often involves longer consultation times. The
The regulatory framework for complementary medicines in Australia
In Australia, medicinal products containing herbs, vitamins, minerals, and nutritional supplements, homoeopathic medicines and certain aromatherapy products are referred to as ‘complementary medicines’. These are regulated as medicines under the Therapeutics Goods Act 1989 (the Act). Complementary medicines comprise traditional medicines, including traditional Chinese medicines, Ayurvedic medicines and Australian indigenous medicines.24
Advisory Committee on Complementary Medicines (ACCM), TGA
The Advisory Committee on Complementary Medicines (ACCM) was formed in January 2010 to advise and make recommendations to the TGA on the inclusion, variation or retention of a complementary medicine in the Australian Register of Therapeutic Goods.25
ACCM may also provide advice to the TGA on any other
Advisory Committee on the Safety of Medicines (ACSOM), TGA Reporting of adverse drug reactions for CMs
The Advisory Committee on the Safety of Medicines (ACSOM) was formed in January 2010 to advise and make recommendations to the TGA on the:
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safety of medicines and
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risk assessment and risk management of medicines.
ACSOM may also provide advice to the TGA on other matters related to the detection, assessment, understanding and prevention of adverse effects, known as pharmacovigilance, and any other matters referred to it by the TGA.
ACSOM supersedes and expands upon the role of the Adverse Drug
Australian College of Nutritional and Environmental Medicine (ACNEM)
ACNEM (Australasian College of Nutritional and Environmental Medicine) is a postgraduate medical college established in the early 1980s. It is independent of all governments, government agencies and other organisations and relies on no other body for funding. It is a non-profit organisation, funded from membership fees, subscriptions, courses and other programmes, book sales and donations. The College is set up as an incorporated association.
ACNEM training is designed for
Non medical CM professional bodies
Please refer to the weblinks below to find more information on the codes of ethics, registration criteria and continuing professional development expectations for each discipline.
Education and training
The RACGP has developed an Integrative Medicine Network within its National Faculty of Specific Interests for GPs. In future this Network may be able to offer an accreditation system and education standards for doctors practising in Australia under the umbrella of the RACGP.
Conclusion
The authors recognise that legitimate standards of medical practice are rooted in competent and reliable scientific evidence and clinical experience. However, these standards are subject to continual change and improvement as advances are made in scientific research and analysis. In addition, standards of medical practice to some degree and the provision of medical services in individual circumstances in particular, are influenced by psychological, social, political and market forces. It is the
Acknowledgments
The ‘Best Practice for Integrative Medicine in Australian Medical Practice’ is an AIMA endorsed document originally developed by the RACGP/AIMA Joint Working Party (JWP) as principles to assist medical practitioners for the safe and appropriate integration of evidence-based complementary medicine into medical practice. These principles were originally adapted from the ‘Model Guidelines for the Use of Complementary and Alternative Therapies in Medical Practice’ (A Policy Document of the
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